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Braunstein M, Barry B, Steel J, Ukovich D, Grimes J, Conlan D, Jones S, Dobbins C, Hansen D. CBL on FHIR: A FHIR-Based Platform for Health Professional Education. Stud Health Technol Inform 2024; 310:1166-1170. [PMID: 38269998 DOI: 10.3233/shti231148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
A FHIR based platform for case-based instruction of health professions students has been developed and field tested. The system provides a non-technical case authoring tool; supports individual and team learning using digital virtual patients; and allows integration of SMART Apps into cases via its simulated EMR. Successful trials at the University of Queensland have led to adoption at the University of Melbourne.
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Affiliation(s)
| | | | - Jim Steel
- CSIRO Australian e-Health Research Centre
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2
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Whelehan P, Ali K, Vinnicombe S, Ball G, Cox J, Farry P, Jenkin M, Lowry K, McIntosh SA, Nutt R, Oeppen R, Reilly M, Stahnke M, Steel J, Sim YT, Warwick V, Wilkinson L, Zafeiris D, Evans AJ. Digital breast tomosynthesis: sensitivity for cancer in younger symptomatic women. Br J Radiol 2021; 94:20201105. [PMID: 33411577 DOI: 10.1259/bjr.20201105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Full-field digital mammography (FFDM) has limited sensitivity for cancer in younger women with denser breasts. Digital breast tomosynthesis (DBT) can reduce the risk of cancer being obscured by overlying tissue. The primary study aim was to compare the sensitivity of FFDM, DBT and FFDM-plus-DBT in women under 60 years old with clinical suspicion of breast cancer. METHODS This multicentre study recruited 446 patients from UK breast clinics. Participants underwent both standard FFDM and DBT. A blinded retrospective multireader study involving 12 readers and 300 mammograms (152 malignant and 148 benign cases) was conducted. RESULTS Sensitivity for cancer was 86.6% with FFDM [95% CI (85.2-88.0%)], 89.1% with DBT [95% CI (88.2-90%)], and 91.7% with FFDM+DBT [95% CI (90.7-92.6%)]. In the densest breasts, the maximum sensitivity increment with FFDM +DBT over FFDM alone was 10.3%, varying by density measurement method. Overall specificity was 81.4% with FFDM [95% CI (80.5-82.3%)], 84.6% with DBT [95% CI (83.9-85.3%)], and 79.6% with FFDM +DBT [95% CI (79.0-80.2%)]. No differences were detected in accuracy of tumour measurement in unifocal cases. CONCLUSIONS Where available, DBT merits first-line use in the under 60 age group in symptomatic breast clinics, particularly in women known to have very dense breasts. ADVANCES IN KNOWLEDGE This study is one of very few to address the accuracy of DBT in symptomatic rather than screening patients. It quantifies the diagnostic gains of DBT in direct comparison with standard digital mammography, supporting informed decisions on appropriate use of DBT in this population.
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Affiliation(s)
- Patsy Whelehan
- School of Medicine, University of Dundee, Mailbox 4, Ninewells Hospital & Medical School, Dundee, UK.,NHS Tayside, Dundee, UK
| | - Kulsam Ali
- School of Medicine, University of Dundee, Mailbox 4, Ninewells Hospital & Medical School, Dundee, UK
| | | | - Graham Ball
- Nottingham Trent University, Nottingham, UK & Intelligent OMICS Ltd, Nottingham, UK
| | - Julie Cox
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Paul Farry
- Western Health and Social Care Trust, Londonderry, UK
| | | | - Keith Lowry
- Belfast Health and Social Care Trust, Belfast, UK
| | | | - Rachel Nutt
- School of Medicine, University of Dundee, Mailbox 4, Ninewells Hospital & Medical School, Dundee, UK
| | - Rachel Oeppen
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Michaela Stahnke
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Violet Warwick
- School of Medicine, University of Dundee, Mailbox 4, Ninewells Hospital & Medical School, Dundee, UK
| | | | - Dimitrios Zafeiris
- Nottingham Trent University, Nottingham, UK & Intelligent OMICS Ltd, Nottingham, UK
| | - Andrew J Evans
- School of Medicine, University of Dundee, Mailbox 4, Ninewells Hospital & Medical School, Dundee, UK
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Braunstein ML, Oancea I, Barry BK, Darlington S, Steel J, Hansen DP, Battock J, Cheung D, Gan G, Hooper B, Lundin R, Nicol D, O'Brien J, Whittington S, Wilkinson C, Wong TT. The development and electronic delivery of case-based learning using a fast healthcare interoperability resource system. JAMIA Open 2020; 2:440-446. [PMID: 32025640 PMCID: PMC6994000 DOI: 10.1093/jamiaopen/ooz055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/20/2019] [Accepted: 10/04/2019] [Indexed: 11/24/2022] Open
Abstract
HL7 International’s Fast Healthcare Interoperability Resources (FHIR) standard provides a common format for sharing health data (eg, FHIR resources) and a RESTful Application Programming Interface (eg, FHIR API) for accessing those resources via a FHIR server connected to an electronic health record system or any other system storing clinical data. Substitutable Medical Applications and Reusable Technologies (SMART) leverages FHIR to create an electronic health record (EHR) agnostic app platform. It utilizes the OAuth standard to provide for authorization and authentication. This paper describes the development and informal evaluation of Case Based Learning on FHIR (CBL on FHIR), a prototype EHR-connected FHIR/SMART platform to provide interactive digital cases for use in medical education. The project goals were to provide a more interactive form of CBL than is possible on paper to more realistically simulate clinical decision making and to expose medical students to modern informatics systems and tools for use in patient care.
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Affiliation(s)
- Mark L Braunstein
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, Georgia, USA.,The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Iulia Oancea
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Benjamin K Barry
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sharon Darlington
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jim Steel
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - David P Hansen
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - James Battock
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Daniel Cheung
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Gregory Gan
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Ben Hooper
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Reilly Lundin
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Duncan Nicol
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Joshua O'Brien
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Scott Whittington
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Chris Wilkinson
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Tse Tse Wong
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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4
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Nguyen A, Hassanzadeh H, Zhang Y, O'Dwyer J, Conlan D, Lawley M, Steel J, Loi K, Rizzo P. A Decision Support System for Pathology Test Result Reviews in an Emergency Department to Support Patient Safety and Increase Efficiency. Stud Health Technol Inform 2019; 264:729-733. [PMID: 31438020 DOI: 10.3233/shti190319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The review of pathology test results for missed diagnoses in Emergency Departments is time-consuming, laborious, and can be inaccurate. An automated solution, with text mining and clinical terminology semantic capabilities, was developed to provide clinical decision support. The system focused on the review of microbiology test results that contained information on culture strains and their antibiotic sensitivities, both of which can have a significant impact on ongoing patient safety and clinical care. The system was highly effective at identifying abnormal test results, reducing the number of test results for review by 92%. Furthermore, the system reconciled antibiotic sensitivities with documented antibiotic prescriptions in discharge summaries to identify patient follow-ups with a 91% F-measure - allowing for the accurate prioritization of cases for review. The system dramatically increases accuracy, efficiency, and supports patient safety by ensuring important diagnoses are recognized and correct antibiotics are prescribed.
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Affiliation(s)
- Anthony Nguyen
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Hamed Hassanzadeh
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Yushi Zhang
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - John O'Dwyer
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - David Conlan
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Michael Lawley
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Jim Steel
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Kylynn Loi
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Peter Rizzo
- The Prince Charles Hospital, Department of Health, Brisbane, Queensland, Australia
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5
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Abstract
Background Even though several high-quality clinical terminologies, such as SNOMED CT and LOINC, are readily available, uptake in clinical systems has been slow and many continue to capture information in plain text or using custom terminologies. This paper discusses some of the challenges behind this slow uptake and describes a clinical terminology server implementation that aims to overcome these obstacles and contribute to the widespread adoption of standardised clinical terminologies. Results Ontoserver is a clinical terminology server based on the Fast Health Interoperability Resources (FHIR) standard. Some of its key features include: out-of-the-box support for SNOMED CT, LOINC and OWL ontologies, such as the Human Phenotype Ontology (HPO); a fast, prefix-based search algorithm to ensure users can easily find content and are not discouraged from entering coded data; a syndication mechanism to facilitate keeping terminologies up to date; and a full implementation of SNOMED CT’s Expression Constraint Language (ECL), which enables sophisticated data analytics. Conclusions Ontoserver has been designed to overcome some of the challenges that have hindered adoption of standardised clinical terminologies and is used in several organisations throughout Australia. Increasing adoption is an important goal because it will help improve the quality of clinical data, which can lead to better clinical decision support and ultimately to better patient outcomes.
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Affiliation(s)
- Alejandro Metke-Jimenez
- The Australian e-Health Research Centre, CSIRO, Level 5 UQ Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia.
| | - Jim Steel
- The Australian e-Health Research Centre, CSIRO, Level 5 UQ Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - David Hansen
- The Australian e-Health Research Centre, CSIRO, Level 5 UQ Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Michael Lawley
- The Australian e-Health Research Centre, CSIRO, Level 5 UQ Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
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Murali A, Ramlogan-Steel C, Andrzejewski S, Dhungel B, Steel J, Layton C. The 8-fold quadrant dissection method for ex vivo human interventional retinal experimentation. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.01558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Murali
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Ophthalmology Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
| | - C. Ramlogan-Steel
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Ophthalmology Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
| | - S. Andrzejewski
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Ophthalmology Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
| | - B. Dhungel
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Liver Cancer Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
| | - J. Steel
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Liver Cancer Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
| | - C. Layton
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Ophthalmology Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
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7
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Layton C, Dhungel B, Andrzejewski S, Jayachandran A, Murali A, Ramlogan-Steel C, Steel J. Gene therapy targeting of choroidal disease and AAV transcytosis through the outer blood retina barrier epithelium. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. Layton
- Gallipoli Medical Research Institute; University of Queensland; Greenslopes Australia
| | - B. Dhungel
- Gallipoli Medical Research Institute; University of Queensland; Greenslopes Australia
| | - S. Andrzejewski
- Gallipoli Medical Research Institute; University of Queensland; Greenslopes Australia
| | - A. Jayachandran
- Gallipoli Medical Research Institute; University of Queensland; Greenslopes Australia
| | - A. Murali
- Gallipoli Medical Research Institute; University of Queensland; Greenslopes Australia
| | - C. Ramlogan-Steel
- Gallipoli Medical Research Institute; University of Queensland; Greenslopes Australia
| | - J. Steel
- Gallipoli Medical Research Institute; University of Queensland; Greenslopes Australia
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8
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Goh A, Ramlogan-Steel C, Jayachandran A, Steel J, Layton C. Genetic evidence for the role of ultraviolet radiation in the pathogenesis of uveal melanoma. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.02787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Goh
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Ophthalmology Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
| | - C. Ramlogan-Steel
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Ophthalmology Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
| | - A. Jayachandran
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Liver Cancer Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
| | - J. Steel
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Liver Cancer Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
| | - C. Layton
- Faculty of Medicine; University of Queensland; Brisbane Australia
- Ophthalmology Research Unit; Gallipoli Medical Research Institute; Greenslopes Australia
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9
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Allgood PC, Maroni R, Hudson S, Offman J, Turnbull AE, Peacock L, Steel J, Kirby G, Ingram CE, Somers J, Fuller C, Threlfall AG, Gabe R, Maxwell AJ, Patnick J, Duffy SW. Effect of second timed appointments for non-attenders of breast cancer screening in England: a randomised controlled trial. Lancet Oncol 2017; 18:972-980. [PMID: 28522311 PMCID: PMC5489696 DOI: 10.1016/s1470-2045(17)30340-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/16/2017] [Accepted: 03/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In England, participation in breast cancer screening has been decreasing in the past 10 years, approaching the national minimum standard of 70%. Interventions aimed at improving participation need to be investigated and put into practice to stop this downward trend. We assessed the effect on participation of sending invitations for breast screening with a timed appointment to women who did not attend their first offered appointment within the NHS Breast Screening Programme (NHSBSP). METHODS In this open, randomised controlled trial, women in six centres in the NHSBSP in England who were invited for routine breast cancer screening were randomly assigned (1:1) to receive an invitation to a second appointment with fixed date and time (intervention) or an invitation letter with a telephone number to call to book their new screening appointment (control) in the event of non-attendance at the first offered appointment. Randomisation was by SX number, a sequential unique identifier of each woman within the NHSBSP, and at the beginning of the study a coin toss decided whether women with odd or even SX numbers would be allocated to the intervention group. Women aged 50-70 years who did not attend their first offered appointment were eligible for the analysis. The primary endpoint was participation (ie, attendance at breast cancer screening) within 90 days of the date of the first offered appointment; we used Poisson regression to compare the proportion of women who participated in screening in the study groups. All analyses were by intention to treat. This trial is registered with Barts Health, number 009304QM. FINDINGS We obtained 33 146 records of women invited for breast cancer screening at the six centres between June 2, 2014, and Sept 30, 2015, who did not attend their first offered appointment. 26 054 women were eligible for this analysis (12 807 in the intervention group and 13 247 in the control group). Participation within 90 days of the first offered appointment was significantly higher in the intervention group (2861 [22%] of 12 807) than in the control group (1632 [12%] of 13 247); relative risk of participation 1·81 (95% CI 1·70-1·93; p<0·0001). INTERPRETATION These findings show that a policy of second appointments with fixed date and time for non-attenders of breast screening is effective in improving participation. This strategy can be easily implemented by the screening sites and, if combined with simple interventions, could further increase participation and ensure an upward shift in the participation trend nationally. Whether the policy should vary by time since last attended screen will have to be considered. FUNDING National Health Service Cancer Screening Programmes and Department of Health Policy Research Programme.
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Affiliation(s)
- Prue C Allgood
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Judith Offman
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anne E Turnbull
- Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Southern Derbyshire Breast Screening Service, Derby, UK
| | - Lesley Peacock
- Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Humberside Breast Screening Service, Cottingham, UK
| | - Jim Steel
- Plymouth Hospitals NHS Trust, Derriford Hospital, Primrose Breast Care Centre, Plymouth, UK
| | - Geraldine Kirby
- South East London Breast Screening Programme, King's College Hospital NHS Foundation Trust, London, UK
| | - Christine E Ingram
- Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield Breast Screening Unit, Sheffield, UK
| | - Julie Somers
- West of London Breast Screening Service, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Clare Fuller
- West of London Breast Screening Service, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - Rhian Gabe
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
| | - Anthony J Maxwell
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Nightingale Centre, University Hospital of South Manchester, Manchester, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Gilbert A, Steel J, Rachel D, Jaggi A. Identifying barriers and facilitators to engaging in clinical research within an NHS Therapies Department: results of a listening exercise. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sankaye P, Chhatani S, Porter G, Steel J, Doyle S. Is axillary sonographic staging less accurate in invasive lobular breast cancer than in ductal breast cancer? J Ultrasound Med 2014; 33:1805-1810. [PMID: 25253827 DOI: 10.7863/ultra.33.10.1805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether axillary sonography is less accurate in invasive lobular breast cancer than in ductal breast cancer. METHODS Patients with invasive breast cancer were retrospectively identified from histologic records from 2010 to 2012. Staging axillary sonograms from 96 patients with primary breast cancer in each of 2 subgroups, invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC), were reviewed. Preoperative sonographically guided 14-gauge core biopsy was performed on morphologically abnormal lymph nodes. RESULTS Thirty-one of 96 patients (32%) in each subgroup were node positive on final postoperative histopathologic analysis. Axillary staging sensitivity was 17 of 31 patients (54%) in the IDC subgroup and 15 of 31(48%) in the ILC subgroup. Further analysis of the data showed no statistically significant differences between these subgroups. CONCLUSIONS We found that there was no statistically significant difference in the accuracy of axillary sonographic staging between ILC and IDC.
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Affiliation(s)
- Prashant Sankaye
- Plymouth Hospitals NHS Trust and Peninsula Radiology Academy, Plymouth, England.
| | - Sharmila Chhatani
- Plymouth Hospitals NHS Trust and Peninsula Radiology Academy, Plymouth, England
| | - Gareth Porter
- Plymouth Hospitals NHS Trust and Peninsula Radiology Academy, Plymouth, England
| | - Jim Steel
- Plymouth Hospitals NHS Trust and Peninsula Radiology Academy, Plymouth, England
| | - Sarah Doyle
- Plymouth Hospitals NHS Trust and Peninsula Radiology Academy, Plymouth, England
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12
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Gray R, Porter G, Steel J. PB.22: Does the Nottingham predictor of bidimensional product of calcium accurately predict the success of wide local excision for ductal carcinoma in situ surgery in our centre? Breast Cancer Res 2013. [PMCID: PMC3980307 DOI: 10.1186/bcr3522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gray R, Porter G, Steel J. PB.30: What is your biopsy threshold in symptomatic clinic and what should it be? B2:B5 biopsy ratio: 18 months in our centre. Breast Cancer Res 2013. [PMCID: PMC3980379 DOI: 10.1186/bcr3530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- R Gray
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - G Porter
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - J Steel
- Plymouth Hospitals NHS Trust, Plymouth, UK
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Sankaye P, Porter G, Steel J, Doyle S. Is ultrasound axillary staging less accurate in invasive lobular breast cancer than in ductal breast cancer? Breast Cancer Res 2012. [PMCID: PMC3542673 DOI: 10.1186/bcr3251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Murphy S, Akinyemi A, Steel J, Petillot Y, Poole I. Multi-compartment heart segmentation in CT angiography using a spatially varying gaussian classifier. Int J Comput Assist Radiol Surg 2012; 7:829-36. [PMID: 22644384 DOI: 10.1007/s11548-012-0695-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/19/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A fully automated and efficient method for segmenting ten major structures within the heart in Cardiac CT Angiography data for the purposes of display or cardiac functional analysis. MATERIALS AND METHODS A spatially varying Gaussian classifier is a flexible model for segmentation, combining the advantages of atlas-based frameworks, with supervised intensity models. It is composed of an independent Gaussian classifier at each voxel and uses non-rigid registration for the initial spatial alignment. We show how this large model can be trained efficiently and present a novel smoothing technique based on normalised convolution to mitigate inherent overfitting issues. The 30 datasets used in this study are selected from a variety of different scanners in order to test the robustness and stability of the algorithm. The datasets were manually segmented by a trained clinician. RESULTS The method was evaluated in a leave-one-out fashion, and the results were compared to other state of the art methods in the field, with a mean surface-to-surface distance of between 0.61 and 2.12 mm for different compartments. CONCLUSION The accuracy of this method is comparable to other state of the art methods in the field. Its benefits lie in its conceptual simplicity and its general applicability. Only one non-rigid registration is required, giving it a speed advantage over multi-atlas approaches. Further accuracy may be achievable through the incorporation of an explicit shape model.
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Affiliation(s)
- S Murphy
- Toshiba Medical Visualization Systems Europe, Edinburgh, UK.
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Sankaye P, Chhatani S, Doyle S, Steel J, Paisley K, Lyons B, Watkins R, Porter G. Preoperative sonographic axillary staging in breast cancer: correlation with sentinel node sampling. Breast Cancer Res 2011. [PMCID: PMC3238270 DOI: 10.1186/bcr2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Johnson S, Brown S, Porter G, Steel J, Paisley K, Watkins R, Holgate C. Staging primary breast cancer. Are there tumour pathological features that correlate with a false-negative axillary ultrasound? Clin Radiol 2011; 66:497-9. [DOI: 10.1016/j.crad.2010.11.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 11/11/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022]
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Cho SW, Steel J, Tsung A, Marsh JW, Geller DA, Gamblin TC. Safety of liver resection in the elderly: how important is age? Ann Surg Oncol 2010; 18:1088-95. [PMID: 21046265 DOI: 10.1245/s10434-010-1404-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND With the aging population, more elderly patients are being considered for hepatic resection. We investigated whether advanced age was associated with higher rate and severity of postoperative complications. METHODS A total of 75 patients aged ≥70 years (group E) were matched with 75 patients aged <70 years (group Y) by the extent of liver resection and by operative indications. Primary outcome measures were rates and severity of complications. Secondary outcome measures were length of hospital stay and discharge destination. Univariate analysis was also performed to identify variables associated with higher surgical risk. RESULTS Male-to-female ratio was 43:32 in both groups. Overall complication rates were 44 and 33.3% in group E and Y, respectively (P = 0.241; odds ratio = 1.57; 95% confidence interval [95% CI], 0.81-3.05). There was no mortality in both groups. The only postoperative age-related morbidity was confusion in the elderly. There was no difference in the rates of severe complications (grade ≥3) between group E and group Y (16 vs. 14.7%; P = 0.744; odds ratio = 1.11; 95% CI, 0.46-2.70). Median length of hospital stay were 7 and 6 days, respectively (P = 0.01). Nineteen percent and 1% of patients in group E and group Y were discharge to rehabilitation facilities, respectively (P = 0.001). Univariate analysis showed that preoperative systemic chemotherapy and longer operative time were associated with higher morbidity in the elderly. CONCLUSIONS Liver resection can be performed in patients aged ≥70 years as safely as in younger patients. Duration and timing of systemic chemotherapy before liver resection should be optimized to minimize postoperative morbidity.
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Affiliation(s)
- S W Cho
- UPMC Liver Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Bunting D, Holgate C, Steel J, Watkins R. Breast Cancer in Association with Radial Scar/Complex Sclerosing Lesion (rs/csl): Long Term Follow Up and Risk of Subsequent Breast Cancer. Int J Surg 2010. [DOI: 10.1016/j.ijsu.2010.07.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Bunting D, Watkins R, Steel J, Holgate C. Predisposition to breast cancer: the risk associated with radial scar/complex sclerosing lesions (RS/CSL). Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Hall SJ, Brown SE, Porter GJR, Steel J, Paisley K, Watkins RM, Holgate C. Negative axillary ultrasound in primary breast cancer: how reassured should we really be? Breast Cancer Res 2009. [PMCID: PMC4284851 DOI: 10.1186/bcr2390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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22
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Hall SJ, Brown SE, Porter GJR, Steel J, Paisley K, Watkins RM, Holgate C. Axillary ultrasound in staging breast cancer: diagnostic accuracy and effect on subsequent axillary surgery - the Plymouth experience. Breast Cancer Res 2009. [PMCID: PMC4284852 DOI: 10.1186/bcr2391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Steel J, Cole C, Sherlock M. Providing inpatient education on a segregated ward. J Cyst Fibros 2009. [DOI: 10.1016/s1569-1993(09)60371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Porter G, Steel J, Paisley K, Watkins R, Holgate C. Incidental breast masses detected by computed tomography: are any imaging features predictive of malignancy? Clin Radiol 2009; 64:529-33. [DOI: 10.1016/j.crad.2009.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 01/14/2009] [Accepted: 01/20/2009] [Indexed: 11/15/2022]
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25
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Abstract
BACKGROUND The Neuroform stent can help in the treatment of difficult, wide-necked intracranial aneurysms. The objective of our study is to report some of the challenges associated with the Neuroform stent in the treatment of intracranial aneurysms. METHODS From January 2003 to August 2006, consecutive patients treated with Neuroform stent for intracranial aneurysms were prospectively enrolled. Information on patient demographics, cerebrovascular risk factors, aneurysm size and location were collected. Technical and clinical complications as well as clinical outcomes were measured. Data were analyzed retrospectively using SPSS software version 11.5. RESULTS Successful deployment of the stent, in the target artery, was achieved in 65/67 (97%) patients. Stent deployment failed in two cases and the migration of stent developed in one during coiling. Postoperative thromboembolic events developed in three patients. These three patients possessed hyperactive platelets, and were treated with intravenous eptifibatide. Intraoperative rupture of aneurysm developed in one patient, which was secured by subsequent coiling. Majority of the patients had good outcomes GOS (Glasgow Outcome Score) 1 or NIHSS (National Institute of Health Stroke Scale) 0 in 63/67 (94%), GOS 2 or NIHSS 2 in one patient and GOS 3 or NIHSS 4 was observed in three cases. CONCLUSION Despite a low rate of intraoperative complications, post-procedural thromboembolic events were common in Neuroform stent-treated patients, which might be associated with hyperactive platelets. Further studies are warranted to identify any potential relationship between post-stent hyperactive platelets and thromboembolism.
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Affiliation(s)
- Abutaher M Yahia
- Department of Neurology, Neurosurgery & Radiology, Upstate Medical University, 750 E Adams Street, Syracuse, NY 13210, USA.
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Affiliation(s)
- A Loewenstein
- Tennent Memorial Institute, University of Glasgow, Glasgow
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27
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Abstract
OBJECTIVE To examine changes in perinatal mortality and birth weight of babies born to mothers with pregestational type 1 diabetes over 40 years in a single teaching hospital clinic. METHODS This was a retrospective survey of cases from the combined diabetes and obstetrics antenatal clinic at the Royal Infirmary of Edinburgh and Simpson Memorial Maternity Pavilion, Edinburgh, Scotland. Birth weight, standardized birth weight, and perinatal mortality were obtained from 643 singleton babies born after 28 weeks of gestation to mothers with pregestational type 1 diabetes between 1960 and 1999. RESULTS There was a dramatic improvement in perinatal mortality rate, falling from 225 (per 1,000 total births after 28 weeks of gestation) in the 1960s to 102 in the 1970s, 21 in the 1980s, and 10 in the 1990s (P < .001 for effect of birth year). In contrast, standardized birth weight (adjusted for sex, gestational age, and parity), which was significantly higher than the background population (+1.41 standard deviations above the population norm, P < .001) showed no significant change over time. CONCLUSION Changes in diabetic management and obstetric practice over the 40 years of our survey have resulted in enormous improvements in the outlook for offspring of mothers with diabetes. Somewhat surprisingly this has not been associated with a reduction in overgrowth of the fetus. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- F D Johnstone
- Obstetrics Department, University of Edinburgh, Edinburgh, United Kindgom
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Abstract
This paper reviews a project which opened up a multi-million pound market to Hallite Seals for a new and innovative range of thermoplastic seals and at the same time drastically reduced the cost of existing products. The project duration was kept to one year by taking advantage of new technologies wherever possible. The project not only achieved the marketing objectives within the planned time-scales, it also provided a payback on capital expenditure of over £330 000 in less than 12 months. Severe customer service problems on existing products were eliminated and the value of stocks and work-in-progress was significantly reduced.
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Affiliation(s)
- V L Clark
- Hallite Seals International, Hampton, Middlesex
| | | | - J Steel
- Hallite Seals International, Hampton, Middlesex
| | - S Smith
- Hallite Seals International, Hampton, Middlesex
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Gorla SR, Steel J, Cohn R, Khan SA. Impact of surgical resection of primary breast tumor in stage IV breast cancer on local control and survival. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. R. Gorla
- Northwestern Univ Sch of Medicine, Chicago, IL; Northwestern Univ, Chicago, IL
| | - J. Steel
- Northwestern Univ Sch of Medicine, Chicago, IL; Northwestern Univ, Chicago, IL
| | - R. Cohn
- Northwestern Univ Sch of Medicine, Chicago, IL; Northwestern Univ, Chicago, IL
| | - S. A. Khan
- Northwestern Univ Sch of Medicine, Chicago, IL; Northwestern Univ, Chicago, IL
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Parker M, White R, Leonardsson G, Milligan S, Steel J. Identification of RIP140 as a nuclear receptor cofactor with a role in female reproduction. Ernst Schering Res Found Workshop 2004:23-31. [PMID: 15248502 DOI: 10.1007/978-3-662-05386-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- M Parker
- Institute of Reproduction and Developmental Biology, Faculty of Medicine, Imperial College, London, UK.
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31
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Abstract
Organisms appear to be present in human fetal membranes without any apparent impact on pregnancy maintenance or the fetal brain. A clear link between chorioamnionitis and fetal brain damage suggests that tissue responses at the feto-maternal interface may be the key determinant of whether preterm labour and brain damage occur.
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Affiliation(s)
- M H F Sullivan
- Department of Obstetrics & Gynaecology, Imperial College of Science, Technology & Medicine, Institute of Reproductive & Developmental Biology, Hammersmith Hospital, DuCane Road, London, UK
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Abstract
The number of deaths per year from hepatocellular carcinoma (HCC) exceeds 250000, placing it sixth as the cause of death from cancer worldwide. The primary etiology of most cases of HCC in the US is hepatitis B and/or C. Extensive research has demonstrated that the relationship between hepatitis B infection and the progression to HCC is mediated by the immune system. A substantial, but unrelated literature, describes the relationship between psychosocial factors (e.g., stress, psychiatric morbidity), immune system reactivity, and disease progression in patients with cancer. However, the role of these factors in the progression of HBV-HCC has not been explored. An understanding of the relationship among virology, immunology, and behavior in the development and recurrence of HCC may provide alternative methods for secondary prevention of HCC (e.g., behavioral) until a vaccine and/or pharmacological treatments are developed, feasible, and affordable.
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Affiliation(s)
- J Steel
- Department of Hematology and Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Abstract
The consequences of late referrals for nephrological care include: increased morbidity, poorer quality of life on dialysis and probably increased mortality. Few studies look at the socio-demographic factors which influence referral to the nephrologist. There is good evidence from studies in other areas of health care that socio-demographic and economic factors influence access to health care. It is important that the nephrology community understand whom the individuals are who likely to be referred late so that we can address any inequality in access to services. We studied all of the patients who started renal replacement therapy in our unit over a five-year period, 1st January 1996 to 31st December 2000 (n = 494). We collected data on gender, age at referral, ethnicity, the date that the individual started dialysis as well as the date they were first seen by a nephrologist. We analysed the data to see if age, gender or ethnicity was associated with timing of referral. If an individual had seen a nephrologist more than three months prior to starting dialysis, they were termed 'early referred', if not they were termed 'late referred' Since this was a sociologically driven research project, we set statistical significance at the 10% (0.1) level. Our data showed that gender did not affect the timing of referral (p = ns), ethnicity affected referral in so much as whites were more likely to be referred late than blacks (p = 0.08) but no more so than non-whites (p = ns). People under the age of 30 were statistically more likely to be referred late than people over the age of 30 years (p = 0.027) as were people under the age of 40 (p = 0.047). We interpret these finding as demonstrating that health care professionals are referring older people and people from the black community in good time and that, in contrast to other studies of inequalities in health, these findings demonstrate that the elderly and ethnic minorities are not being disadvantaged.
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Affiliation(s)
- J Steel
- King's College Hospital, London, UK
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35
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Abstract
Understanding of how to analyse and interpret quality of life (QoL) data from clinical trials in patients with advanced cancer is limited. In order to increase the knowledge about the possibilities of drawing conclusions from QoL data of these patients, data from 2 trials were reanalysed. A total of 113 patients with pancreatic, biliary or gastric cancer were included in 2 randomised trials comparing chemotherapy and best supportive care (BSC) with BSC alone. Patient benefit was evaluated by the treating physician (subjective response) and by using selected scales and different summary measures of the EORTC QLQ-C30 questionnaire. An increasing number of drop-outs (mainly due to death) with time did not occur in a random fashion. Therefore, the mean scores in the different subscales of the QLQ-C30 obtained during the follow-up of interviewed patients did not reflect the outcome of the randomised population. The scores of the patient-provided summary measure, 'Global health status/QoL', were stable in a rather high proportion of the patients and could not discriminate between the 2 groups. 3 other summary measures revealed greater variability, and they all discriminated between the 2 groups. A high agreement was also seen between the changes in the summary measures and the subjective response. A categorisation of whether an individual patient had benefited or not from the intervention could overcome the problem with the selective attrition.
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Affiliation(s)
- K Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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36
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Abstract
Adenoviral vectors remain one of the most promising methods of gene delivery but are plagued by several inherent problems including immune inactivation and transient expression. This paper reports a novel microparticle-based delivery system for adenovirus that allows high uptake of virus, stable complex formation and extended release. In addition, this microparticle/adenovirus complex has been demonstrated to only release virus upon cell contact. The significant clinical implications of this delivery system are discussed.
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Affiliation(s)
- H M Cavanagh
- School of Biomedical Sciences, Charles Sturt University, Locked Bag 588, NSW 2678, Wagga Wagga, Australia.
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Abstract
AIMS In the light of goals for reducing blindness due to diabetes, published in the St Vincent Declaration, 1989, the aim of this study was to find the incidence and prevalence of blindness in the diabetic population of Fife. METHODS All blind registrations for the period 1990-9 were studied. Those with diabetes as the first or main diagnosis were included as new diabetic blind. The prevalence of diabetes was studied in a large sample population and extrapolated to the estimated population of Fife. RESULTS The incidence of blindness due to diabetes was 64 (SD 24, 95% CI 49-79) per 100 000 diabetic population/year. The point prevalence of blindness due to diabetes on 31 December 1999 was 210 per 100 000 diabetic population. CONCLUSION The incidence of blindness due to diabetes, in a diabetic population, is now known. Without this benchmark it is impossible to assess the implementation of the St Vincent Declaration.
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Hartnell A, Steel J, Turley H, Jones M, Jackson DG, Crocker PR. Characterization of human sialoadhesin, a sialic acid binding receptor expressed by resident and inflammatory macrophage populations. Blood 2001; 97:288-96. [PMID: 11133773 DOI: 10.1182/blood.v97.1.288] [Citation(s) in RCA: 224] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sialoadhesin is a macrophage-restricted cellular interaction molecule and a prototypic member of the Siglec family of sialic acid binding immunoglobulin (Ig)-like lectins. So far, it has only been characterized in rodents. Here, we report the molecular cloning, binding properties, and expression pattern of human sialoadhesin. The predicted protein sequences of human and mouse sialoadhesin are about 72% identical, with the greatest similarity in the extracellular region, which comprises 17 Ig domains in both species. A recombinant protein consisting of the first 4 N-terminal domains of human sialoadhesin fused to the Fc region of human IgG1 mediated sialic acid-dependent binding with a specificity similar to its mouse counterpart, preferring sialic acid in the alpha2,3 glycosidic linkage over the alpha2,6 linkage. By flow cytometry with peripheral blood leukocytes, recombinant sialoadhesin bound strongly to granulocytes with intermediate binding to monocytes, natural killer cells, B cells, and a subset of CD8 T cells. Using antibodies raised to the recombinant protein, sialoadhesin was immunoprecipitated from the THP-1 human monocytic cell line as an approximate 200-kd glycoprotein. The expression pattern of human sialoadhesin was found to be similar to that of the mouse receptor, being absent from monocytes and other peripheral blood leukocytes, but expressed strongly by tissue macrophages in the spleen, lymph node, bone marrow, liver, colon, and lungs. High expression was also found on inflammatory macrophages present in affected tissues from patients with rheumatoid arthritis.
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Affiliation(s)
- A Hartnell
- Imperial Cancer Research Fund Laboratories, Oxford, United Kingdom
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Floyd H, Ni J, Cornish AL, Zeng Z, Liu D, Carter KC, Steel J, Crocker PR. Siglec-8. A novel eosinophil-specific member of the immunoglobulin superfamily. J Biol Chem 2000; 275:861-6. [PMID: 10625619 DOI: 10.1074/jbc.275.2.861] [Citation(s) in RCA: 160] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe the characterization of siglec-8, a novel sialic acid-binding immunoglobulin-like lectin that is expressed specifically by eosinophils. A full-length cDNA encoding siglec-8 was isolated from a human eosinophil cDNA library. Siglec-8 is predicted to contain three extracellular immunoglobulin-like domains, a transmembrane region, and a cytoplasmic tail of 47 amino acids. The siglec-8 gene mapped on chromosome 19q13.33-41, closely linked to genes encoding CD33 (siglec-3), siglec-5, siglec-6, and siglec-7. When siglec-8 was expressed on COS cells or as a recombinant protein fused to the Fc region of human IgG(1), it was able to mediate sialic acid-dependent binding to human erythrocytes and to soluble sialoglycoconjugates. Using specific monoclonal antibodies, siglec-8 could be detected only on eosinophils and hence appears to be the first example of an eosinophil-specific transmembrane receptor.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antigens, CD/chemistry
- Antigens, CD/genetics
- Antigens, CD/metabolism
- Antigens, Differentiation, B-Lymphocyte/chemistry
- Antigens, Differentiation, B-Lymphocyte/genetics
- Antigens, Differentiation, B-Lymphocyte/metabolism
- Antigens, Differentiation, Myelomonocytic/chemistry
- Antigens, Differentiation, Myelomonocytic/genetics
- COS Cells
- Chromosome Mapping
- Chromosomes, Human, Pair 19
- Eosinophils/immunology
- Erythrocytes/immunology
- Gene Library
- Genetic Linkage
- Granulocytes/immunology
- Humans
- Immunoglobulin Fc Fragments/genetics
- Immunoglobulin G/genetics
- Lectins
- Lymphocytes/immunology
- Molecular Sequence Data
- Monocytes/immunology
- Recombinant Fusion Proteins/metabolism
- Sequence Alignment
- Sequence Homology, Amino Acid
- Sialic Acid Binding Ig-like Lectin 3
- Sialic Acids/blood
- Transfection
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Affiliation(s)
- H Floyd
- The Wellcome Trust Biocentre at Dundee, Department of Biochemistry, University of Dundee, Dundee DD1 5EH, Scotland, United Kingdom
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40
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Affiliation(s)
- C L Thomas
- Molecular Neuropathobiology, Imperial Cancer Research Fund, London, UK
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41
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Bahl S, Martin S, Rawlins P, Sadeghi R, Smith PM, Steel J, Shanu-Wilson P, Wood KA, Wrigley SK. XR651, a novel naphthacene-5,12-dione. J Antibiot (Tokyo) 1997; 50:169-71. [PMID: 9099228 DOI: 10.7164/antibiotics.50.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S Bahl
- London International Group, Research and Development, Cambridge, U.K
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Brown CJ, Dawson A, Dodds R, Gamsu H, Gillmer M, Hall M, Hounsome B, Knopfler A, Ostler J, Peacock I, Rothman D, Steel J. Report of the Pregnancy and Neonatal Care Group. Diabet Med 1996; 13:S43-53. [PMID: 8894455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C J Brown
- Department of Maternity and Gynaecology, North Hampshire Hospital, Basingstoke
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Knox M, Steel J. Nutritional enhancement of parasite control in small ruminant production systems in developing countries of South-East Asia and the Pacific. Int J Parasitol 1996; 26:963-70. [PMID: 8923143 DOI: 10.1016/s0020-7519(96)80072-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nutritional insufficiency and gastrointestinal nematode parasitism are major constraints to small ruminant production in south-east Asia and the Pacific Islands. Research on the effects of low cost supplements which supply nitrogen and essential minerals on the ability of small ruminants to resist infection is summarised. In controlled pen studies in young Merino sheep offered a low quality roughage diet of oaten chaff and essential minerals, supplementation with urea reduced the effects of parasitic infection by increasing weight gain and wool production and reducing faecal egg output and parasite burden. In Fiji, field studies have shown that supplementation with urea-molasses blocks can result in increased live-weights of lambs at weaning, increased reproduction rates in maiden ewes and reduction in faecal egg output in grazing sheep. Additional benefits were derived from the inclusion of anthelmintic in the blocks in similar groups of sheep particularly during periods of greater susceptibility to parasites. Pen studies with young goats have shown that urea supplements alone gave no production benefits, but when accompanied by 100 g/d of cotton seed meal beneficial responses were observed. It is expected that parasite control in the small ruminant production systems of developing countries in south-east Asia and the Pacific Islands will benefit from the introduction of low cost nitrogen supplements along with anthelmintic therapy delivered strategically by molasses blocks.
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Affiliation(s)
- M Knox
- CSIRO, Division of Animal Production, Armidale, NSW, Australia.
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45
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Steel J. What next in the treatment of diabetes? Practitioner 1996; 240:116-9. [PMID: 8736200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- J Steel
- Victoria Hospital, Kirkcaldy
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46
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Brown D, Sadeghi R, Steel J, Moore M, Gammon G. Detection of interleukin-1 signal transduction inhibitors: action of protein kinase inhibitors. Int J Immunopharmacol 1995; 17:887-94. [PMID: 8788118 DOI: 10.1016/0192-0561(95)00085-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The dysregulated production of IL-1 has been shown to play an important role in many pathological processes. Despite the apparent value of compounds able to inhibit either the secretion of IL-1 or its signal transduction pathway in a specific manner, there are no such compounds suitable for clinical use. A major problem in identifying novel and specific inhibitors of signal transduction is the lack of knowledge of the intracellular events which mediate the cellular actions of IL-1. In this study a simple cellular assay has been established to screen natural product and synthetic compound libraries for low molecular weight inhibitors of the cytokine signalling pathways of potential therapeutic value. In addition, we have studied the action of several known modulators of signal transduction on the actions of IL-1.
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Abstract
The inappropriate use of Accident and Emergency (A & E) departments by the public has been the subject of debate for many years. Patients often attend departments with problems which could equally have been treated by the primary care services in the community. However, despite much research into why patients choose to visit A & E departments rather than their general practitioners, efforts to reverse this trend have generally failed. If the professional view of what is appropriate cannot be enforced, perhaps the label 'inappropriate' belongs to the A & E services rather than the patient.
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Affiliation(s)
- J Steel
- Aged Care Services, Heidelberg Hospital, Victoria, Australia
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49
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Clochesy JM, Daly BJ, Idemoto BK, Steel J, Fitzpatrick JJ. Preparing advanced practice nurses for acute care. Am J Crit Care 1994; 3:255-9. [PMID: 7920952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND As a result of changes occurring in healthcare, providers have become increasingly specialized, resulting in fragmented care of patients and their families. With these changes, the need has developed for professionals who possess both advanced clinical decision-making ability and expanded psychomotor skills to serve as case managers in collaboration with physicians. As a result, evolving and innovative roles for advanced practice nurses have developed in American hospitals. The development of such roles, within the acute care hospital environment, has led directly to the creation of graduate programs to prepare acute care nurse practitioners. OBJECTIVE This article describes the efforts to develop a specific graduate program to prepare nurses as acute care nurse practitioners. These efforts include the needs assessment, curriculum and role development, implementation, and evaluation of the program. RESULTS Phase 1 evaluation showed significant support for acute care nurse practitioners. External support for the training and use of nurse practitioners in acute care was evidenced by significant financial support for this program provided by an acute care hospital and a private foundation. The first graduates are now practicing as acute care nurse practitioners; Phase 2 evaluation of patient outcomes is under way. CONCLUSION The emergence of acute care nurse practitioners has been stimulated by changes in American healthcare. Support for the use of acute care nurse practitioners is significant, but barriers to implementing the role and patient and fiscal outcomes must be studied.
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Affiliation(s)
- J M Clochesy
- Case Western Reserve University, Cleveland, Ohio
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Abstract
BACKGROUND: As a result of changes occurring in healthcare, providers have become increasingly specialized, resulting in fragmented care of patients and their families. With these changes, the need has developed for professionals who possess both advanced clinical decision-making ability and expanded psychomotor skills to serve as case managers in collaboration with physicians. As a result, evolving and innovative roles for advanced practice nurses have developed in American hospitals. The development of such roles, within the acute care hospital environment, has led directly to the creation of graduate programs to prepare acute care nurse practitioners. OBJECTIVE: This article describes the efforts to develop a specific graduate program to prepare nurses as acute care nurse practitioners. These efforts include the needs assessment, curriculum and role development, implementation, and evaluation of the program. RESULTS: Phase 1 evaluation showed significant support for acute care nurse practitioners. External support for the training and use of nurse practitioners in acute care was evidenced by significant financial support for this program provided by an acute care hospital and a private foundation. The first graduates are now practicing as acute care nurse practitioners; Phase 2 evaluation of patient outcomes is under way. CONCLUSION: The emergence of acute care nurse practitioners has been stimulated by changes in American healthcare. Support for the use of acute care nurse practitioners is significant, but barriers to implementing the role and patient and fiscal outcomes must be studied.
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